Endoscopic vacuum-assisted closure for pediatric esophageal perforations: a systematic review and individual patient...

Esophageal leaks and perforations in children are uncommon, but potentially life-threatening conditions associated with substantial morbidity. Endoscopic vacuum-assisted closure (EVAC) and related vacuum-based techniques have emerged as minimally invasive alternatives to conventional management, but pediatric evidence remains limited to small observational studies. We performed a systematic review and meta-analysis to evaluate the safety and effectiveness of vacuum-based therapy for pediatric esophageal leaks and perforations.

PubMed, Embase, and Cochrane Library were searched from inception to May 21, 2026. The primary outcome was a successful leak closure. Secondary outcomes included treatment escalation, clinically relevant complications, treatment duration, number of device revisions, and functional outcomes. IPD was synthesized using one-stage models accounting for clustering by study, with complementary aggregate-level analyses when compatible data were available.

Eight observational studies, comprising 52 patients overall. Seven studies provided IPD for 35 patients, while one study contributed aggregate-level data only. In the IPD cohort, successful closure was achieved in 33 of 35 patients, corresponding to a crude proportion of 94.3% (95% CI, 81.4-98.4). Clinically relevant complications occurred in 16 of 35 patients, with stricture being the most frequent complication. Rescue surgery was required in 6 of 35 patients. In complementary aggregate-level analysis, successful closure was achieved in 48 of 52 patients, with a pooled proportion of 99.81% (95% CI, 92.11-100.00; I² = 0%). No evaluated predictor was significantly associated with successful closure or clinically relevant complications.

Vacuum-based therapy for pediatric esophageal leaks and perforations was associated with high rates of defect closure in the available literature. Further operations were required in a minority of patients and generally addressed late complications, such as stricture, after leak closure. EVAC and related techniques appear promising for carefully selected children with accessible leaks or perforations, but standardized prospective data are needed before definitive practice recommendations can be made.